Signs of SSS on the ECG and treatment at diagnosis

Sick sinus syndrome (SSS) is a physiological process when a set of cells that regulate the independent contractile movements of the heart are unable to timely develop healthy impulses in the body and pass them through the myocardium.

Because of this, the normal pulsation is reduced (less than 50 times per minute), and a person may experience a state of arrhythmia as a result of the formation of additional signals from low-active foci that can create excitation.

Such a change in the functioning of the heart worsens the condition of a sick person the more rarely this organ contracts: from the absolute absence of symptoms and slight fatigue to fainting, disability and the risk of sudden death.

Cardiologists-arrhythmologists, as well as cardiac surgeons, are engaged in specialized therapy of SSSU in medical centers. Thanks to modern methods of treatment, the disease can be completely eliminated or a full-fledged heart rhythm can be established.

Causes of SSSU

Initially, sinus node dysfunction and incomplete functioning were combined into one, but now it is believed that the first is a transient condition and is due to functional disorders, while the second is caused by myocardial damage.

• age-related atrophy and simplification of organ development - slowing down the work of pacemaker cells as a result of age features;
• congenital pathology of the central nervous system, manifested in dysfunction of the regulation of sinus activity and a change in the tone of blood vessels, which causes a decrease and increase in pressure.

• amyloidosis - accumulation in the myocardium of a malignant protein compound - amyloid;
• autoimmune violation of the heart muscle as a result of systemic actions - lupus, rheumatism;
• postviral myocarditis - inflammatory processes in the tissue of the heart muscle, affecting the right atrium.

The influence of certain chemicals (antiarrhythmic drugs, organophosphorus mixtures, and others) and their characteristic manifestations disappear after their action is stopped and the detoxification procedure is carried out.

Circumstances that cause problems in adults (over 50 years old), in addition to the above items, can be:

• ischemia. Subsequently, blood circulation in the area of ​​the sinus node is disturbed;
• post-myocardial infarction with further irreversible changes in scars affecting the sinus node.

• internal. These are diseases during which the structure of the muscular connective structure of the heart changes, local blood flow deteriorates during thrombosis, infarction or ischemia. Also, the normal functioning of the sinus node is affected by inflammation of the heart muscle, for example, pericarditis, cardiomyopathy;
• the second group of sources includes external causes, when the pathogenesis proceeds without changes in the heart. These include pharmaceutical preparations, the active element of which negatively affects the conductivity of the node.

Hypertension, musculoskeletal problems, complications caused by a deficiency of hormones synthesized by the thyroid gland can disrupt the heartbeat.

Excessive activity of the vagus nerve is also added to the external factor, during which dysfunction occurs. The cause of such activity can be natural factors, for example, swallowing, coughing, sleep, or pathological, appearing in diseases of the pharynx, intestines, genitourinary system, high temperature, and pressure.

Regardless of the type of source that causes this pathology, the risk of aggravating SSS lies in the danger of sudden cardiac arrest and, in the absence of surgical medicine, death.

Symptoms

The syndrome can proceed in different ways. In some patients, the clinical picture may not appear for a long time, others notice a noticeable deterioration in heart rhythms, sometimes occurring simultaneously with headaches or dizziness.

There may be a hemodynamic disorder due to a reduction in stroke and minute output, with a parallel course of cardiac asthma, coronary deficiency.

• cerebral. They are manifested by weakness, nervousness, memory impairment, mental instability. The elderly population has a decrease in intellectual ability. With the development of SSSU and a lack of cerebral blood flow, the symptoms increase. There are before fainting, loss of consciousness, before which there is tinnitus, sudden weakness, inhibition of the heart. In addition, the surface of the skin turns pale and cold, blood pressure drops sharply. The cause of fainting can be a cough, a quick turn of the head, a tight collar. Often this condition goes away on its own, but in a protracted case, urgent resuscitation may be required. Severe bradycardia can provoke dyscirculatory encephalopathy (severe dizziness, the appearance of quick gaps in memory, "swallowing" speech, nervousness, deterioration in the ability to remember);
• cardiac. They begin to manifest with the patient's sensations of a slow or unstable pulse, pain in the sternum. Joining complications are characterized by palpitations, failures in cardiac activity, shortness of breath, fatigue.

Against the backdrop of the ongoing development of sinus node problems, ventricular tachycardia or fibrillation is often added, which increase the likelihood of sudden cardiac death. A sick person may also experience oliguria caused by renal hypoperfusion, gastrointestinal dysfunction, intermittent claudication, muscle weakness as a result of insufficient saturation of organs and tissues.

After ectopic rhythms, the habitual sinus pulse returns to normal slowly and comes after a long pause.

Finding and detailing the problem

The main sign due to which SSU syndrome is diagnosed is pronounced bradycardia (reduction of beats to 40-50 beats per minute). Most people with similar rhythm damage are diagnosed as such.

• ECG. Severe forms of the disease are available for diagnosis only if a cardiogram is shown during an attack. Chronic types without permanently present bradycardia are difficult to establish solely by this method.
• An electrocardiogram is recorded throughout the day. During the examination, the sensors are fixed to the patient for 24 hours, and if necessary, longer. The examined person is in the medical center, adhering to the usual physical activity and rest. The cardiogram is recorded continuously throughout the day. If the shortest moments of slowing of the rhythm occur during the examination period, they will be recorded.
• Transesophageal electrical stimulation is a special stimulation of the myocardium with small electric currents through the esophagus. In the study, a tachycardia of about 110 beats per minute should normally occur. In the absence of such a reaction, or if, after the restoration of the normal rhythm, the stop between contractions on the cardiogram is more than 1.5 seconds, the diagnosis of SSSU is confirmed.
• Load and drug tests. If the results of the cardiogram have established a slowdown in the heart rate, which causes suspicion of pathology, it is recommended to carry out specialized electrocardiography procedures: a test with a load (exercise on a stationary bike or squats) and with atropine (a medication is injected that accelerates the beat).

Suspicion of weak sinus node syndrome is positive if, after the test, the heart does not respond with increased contractions of more than 90 beats per minute.

There are additional research methods in cardiology to establish a violation: echocardiography, cardiac tomography, blood tests for the amount of calcium and potassium.

With a low efficiency of these methods, suspicions of a node pathology are confirmed or refuted by an electrophysiological examination.

Treatment of the syndrome

When diagnosing a patient with a violation in the sinus node, the source of which was vegetovascular dystonia, it is initially necessary to obtain recommendations from the departments of neurology and cardiology. As a rule, it is prescribed to maintain a healthy and proper lifestyle, dietary nutrition for SSSU of the heart, the use of vitamins, the intake of anti-allergic and immuno-strengthening drugs. Among the frequently prescribed drugs: tincture of valerian, eleutherococcus root, echinacea flowers. Glycine and magnesium B6 are also recommended for use.

If there is an organic dysfunction that caused the progression of weakness of the sinus node, especially with long pauses in the heartbeat that are dangerous to health and life, a drug treatment of the main pathology (defect, coronary heart disease, and so on) is recommended.

As a result of the fact that for the most part the problem develops to clinically dangerous blockades and long stretches of asystole, which are accompanied by an attack of Morgagni Adams Stokes (MAS), the installation of a pacemaker is shown to the majority of patients as the most effective way to eliminate the disorder. It is an artificial source and pacemaker.

Now the operation can be performed free of charge under the compulsory health insurance system if the patient's request for the service is approved.

If a person has lost consciousness (directly during an attack), or his head is suddenly dizzy, he needs to count the pulse, or, if it is difficult to determine on the carotid artery, count the heart rate by probing or listening to the chest on the left side under the nipple.

1. After the arrival of the medical team or if the patient has the necessary drugs, it is necessary to inject subcutaneously with 3 ml of a 0.1% mixture of atropine sulfate (usually such patients keep everything they need with them, given that a crisis can occur at any time). This drug suppresses the slowing effect of the vagus nerve, as a result of which the sinus section begins to function normally.
2. If the injection did not have the desired effect, and the person does not regain consciousness for more than 3-5 minutes, an indirect heart massage should be performed immediately, since a long pause in the activity of the node can transform into absolute asystole.

Often, the heart rhythm returns to normal without any influence due to signals either from the SU itself or from other sources of irritation located in the right atrium. But despite the fact that if the patient has at least one attack of MAS, you should undergo an examination in the hospital and resolve the issue of installing a pacemaker by the surgical method.

• a decoction of viburnum fruits. You will need two tablespoons of berries one per glass of water. Boil 8 minutes. Divide the resulting portion and consume during the day at regular intervals;
• the heart muscle is well strengthened by the infusion of hawthorn berries, wild rose and motherwort. The listed ingredients must be taken in equal proportions, chopped. Pour three tablespoons of the resulting mixture into a thermos and pour a liter of hot water. Leave overnight, strain the drink in the morning and take half a glass three times a day before meals.

These methods can improve the activity of the heart, relieve symptoms of shortness of breath, stop the progression of heart failure.

Prognosis for the disease

Sinus node weakness syndrome in its course, as a rule, tends to develop, therefore, if there is no timely medical intervention, the clinical picture of the pathology worsens.

To a greater extent, the outcome of the weakness of the sinus node depends on the expression of its dysfunction:

• the most negative combination is sinus bradycardia with atrial tachyarrhythmia;
• to the least extent - together with sinus stops;
• Satisfactory is isolated sinus bradycardia. This is due to the likelihood of progression of thromboembolic consequences in all scenarios of the course, which become the cause of death in 40-50% of patients with SSS.

In general, the syndrome increases the percentage of lethal outcome of the disease by an average of 5% each year, while the development of sudden cardiac death can occur at any time during the course of the disease. The life expectancy of such patients in the absence of therapy varies and can reach from a couple of weeks to 10 years or more.

Preventive measures for the appearance and prevention of the pathology of weakness in the sinus node are based on the timely diagnosis and treatment of severe etiological conditions, the reasonable prescription of antiarrhythmic drugs that affect the work, as well as the conductivity of the sinus node.

In order to prevent uneven contraction of the atria in sick people, it is necessary to perform pacing.